Dr. Dean Kane Q & A
Q. 5 weeks post surgery I have a bump of skin on the back of my right lobe and bumps of skin in front of the left lobe. My surgeon has me massage Avene Cicalfate on my scars but prescribed Fluocinolone Acetonide Cream, USP 0.025% for the bumps on my left lobe. I have been using that twice a day for over two weeks with no improvement. I have read conflicting views on this site re laser/injections/silicone sheets/massage/ etc. How can I help scars look less obvious short and long term?
A. Any time the tissues undergo an injury, a cascade of events occurs to repair the damage. Cells, proteins, blood vessels, nerves, and scaffolding are used in the repair of skin with collagen, ie. scar. Scars become more stiff, thickened and irregular than natural skin. Much of this is because it is collagen in a random alignment that is laid down rather than the basket weave pattern and stretchiness of natural dermis. This allows for strength but not elasticity. It also misses the addition of oil glands which give scars a shiny rather than satin reflection and dry rather than moist texture. Scars typically have no pigment as no melanocytes are weaved into the collagen to tan or form color.
Collagen is the thread that holds the edges of a wound or incision together. As is the ying and yang balance of all body functions, so is it with collagen or scar formation. Changes over time occur. Production and break-down of collagen over 1-2 years yields the strongest, most flexible and thinnest final scar. Patients of color and other individuals of American Indian and Irish descent as well as particular body areas such as around the ears and elsewhere have the propensity to develop thicker, ropier, redder scars for a prolonged time; called hypertrophic scarring. Occasionally, collagen production can so far outweigh collagen break-down that the injury develops a benign tumor which grows bigger than the cut itself. This is called a keloid.
Most of the time, scar production peaks in thickness, lumpiness, swelling, redness and irregularity in 12 weeks (3 months) and has subsided by 6 months. Another 6 months or more of scar remodeling occurs to breakdown the thick, lumpy scar into a smooth, thin sheet or line scar we desire. Occasionally, the breakdown of scar is greater than the buildup quality and quantity of scar and only the epidermis and the very thinned dermis of a “stretch-mark-like” scar results called an atrophic scar.
With this background it is understandable how each patient’s repair process is unique and will differ in quality. While surgeons desire a perfect scar every time, scars are permanent reminders of the injury to the skin of a quality predestined and not overly influenced by surgical technique.
Based on your photos, the quality of your scars will improve with time, massage, steroid and if you can fit it silicone gel sheeting. In our hands, IPL will hasten the remodeling of reddish scars like yours.
Continue with the care of your surgeon. I wish you well.
